Spondyloarthritis

Inflammatory spondyloarthritis (SpA) is a disease involving involvement and chronic inflammation of the joints of the spine.  Axial spondyloarthritis (axSpA) includes patients who have radiographic evidence of lesions in both the sacroiliac joints (radiographic axSpA or AS) and the joints themselves (non-radiographic axSpA). It’s estimated that SpA can affect between 9 and 30 people per 10,000 people.

Symptoms

The initial presentation of symptoms is similar in both sexes, but women are statistically diagnosed later due to less specific symptoms. Over 40% of patients may develop extra-articular lesions, such as those involving the cardiovascular system, during the course of the disease. Depending on gender, different symptoms are more or less common.

Typical symptoms present with SpA are:

• Prolonged back pain
• Back stiffness that worsens at night and subsides with exercise
• Tiredness
• Painful swelling of the joints
• Pain in the heels
• Skin and nail lesions similar to psoriatic lesions
• Episodes of inflammation of the eye (uveitis)
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Symptoms more common in men are:

• Typical inflammatory pain in the sacrum
• A greater predisposition for the disease to occupy the upper thoracic and cervical spine
• Inflammation of the anterior segment of the uveal membrane of the eye
• More frequent radiographic progression to the lumbar spine
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In contrast, it is more common in women:

• Inflammation of tendon attachments with a more severe course than in men
• Inflammatory bowel disease
• Psoriasis
• More frequent radiologic progression of the cervical spine
• Causes and risk factors

Axial spondyloarthropathies are primarily associated with the male gender. However, the clinical picture of this disease isn’t uniform. Several correlations have been noted occurring more frequently in patients of one sex, which may be influenced by sex hormone management.

The probability of developing an axial form of inflammatory spondyloarthropathy is higher:

• In patients with chronic spinal pain
• In patients with the HLA-B27 antigen present and a positive family history of AS, psoriasis, reactive arthritis, inflammatory bowel disease or uveitis
• Men with higher levels of TNFα and interleukin 17A

The incidence of syndesmophytes, the sequelae of progressive degenerative changes involving the spine, is seen in men with higher levels of IL-18, and in women with higher levels of IL-6

Treatment

Treatment of spondyloarthropathy depends on the type and severity of the disease. Similar treatment is also used for patients with AS.

 Treatment options include:

• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate or sulfasalazine
• Physiotherapy – is an extremely important part of the long-term treatment of spine disease
• Biologic drugs – used in patients with inflammatory conditions of the spine, seeming to be the most effective method. Examples include TNF inhibitors, IL-17A inhibitors and other biologic drugs

Treatment may differ between genders. Response to TNFα inhibitors is worse in women compared to men with the same diagnosis. If you notice any symptoms, see a rheumatology specialist and have tests done to confirm inflammatory spondyloarthropathy.